Colorectal cancer differential diagnosis: Difference between revisions

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|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Diseases
! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Diseases
| colspan="4" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Clinical manifestations'''
| colspan="5" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Clinical manifestations'''
! colspan="5" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Para-clinical findings
! colspan="5" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Para-clinical findings
| colspan="1" rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Gold standard'''
| colspan="1" rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Gold standard'''
|-
|-
| colspan="4" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Symptoms'''
| colspan="5" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Symptoms'''
|-
|-
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Lab Findings
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Lab Findings
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! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Blood in stool
! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Blood in stool
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Abdominal pain
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Abdominal pain
![[Tenesmus]]
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Other symptoms
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Other symptoms
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Anemia
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Anemia
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| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" | +/-
| +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
*[[Tenesmus]]
*[[Weight loss]]
*Diminished caliber of stools
*[[Fatigue]]
*Low caliber of stools
*[[Mucus]] in stools
*[[Mucus]] in stools
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
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*[[cancerous]] [[lesions]]
*[[cancerous]] [[lesions]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
*Luminal narrowing and [[bowel obstruction]]
*Luminal narrowing
*Circumferential thickening of the bowel wall
*[[bowel obstruction]]
*[[Enlarged lymph nodes]]
*Thickening of the bowel wall
*Pulmonary [[metastases]]
*[[Lymphadenopathy]]
*Peritoneal metastases
*[[metastases]]
*[[Metastases|Hepatic metastases]]
| style="background: #F5F5F5; padding: 5px;" |'''PET scans'''
| style="background: #F5F5F5; padding: 5px;" |
*Detailed images and metastasis
*[[PET scan|PET scans]]
'''Barium enema'''
**Detailed images and metastasis
*Cancer or a precancerous polyp
*[[Barium enema]]
'''Genetic testing'''
**Cancer or a precancerous polyp
*[[Hereditary nonpolyposis colorectal cancer case study one|Hereditary nonpolyposis colorectal cancer]] (HNPCC)
*[[Genetic testing]]
*[[Familial adenomatous polyposis]] (FAP)
**[[Hereditary nonpolyposis colorectal cancer case study one|Hereditary nonpolyposis colorectal cancer]] (HNPCC)
**[[Familial adenomatous polyposis]] (FAP)
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Different grades of differentiation of glandular structures
* Different grades of differentiation of glandular structures
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| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| -
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[Mucocutaneous]]   [[hyperpigmentation]] (mouth, hands, and feet)
* [[Weight loss]]
* [[Fatigue]]
* [[Fatigue]]
* [[Weight loss]]
* [[Hyperpigmentation|Mucocutaneous  hyperpigmentation]]
* [[Rectal prolapse]]
* [[Rectal prolapse]]
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
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*[[Intussusception]]
*[[Intussusception]]
*[[Bowel obstruction]]
*[[Bowel obstruction]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |[[Barium enema|'''Barium enema''']]
* [[Barium enema]]
* Multiple [[Polyp|polyps]].
** Multiple [[Polyp|polyps]].
[[MRI|'''MRI''']]
* [[MRI]]
* Multiple [[Hamartoma|hamartomatous]] polyps
** Multiple [[Hamartoma|hamartomatous]] polyps
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[Hamartoma|Hamartomatous]] [[Polyps|mucosal polyps]] with central core of branching smooth muscle associated with mucosa
* [[Hamartoma|Hamartomatous]] [[Polyps|mucosal polyps]] with central core of branching smooth muscle associated with mucosa
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| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| -
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
*[[Weight gain|Weight loss]]
*[[Weakness]]
*[[Flushing (physiology)|Flushing]]
*[[Flushing (physiology)|Flushing]]
*[[Wheezing]]
*[[Wheezing]]
*[[Shortness of breath]]
*[[Shortness of breath]]
*[[Palpitations]]
*[[Palpitations]]
*[[Weight gain]]
*[[Hirsutism]]
*[[Weakness]]
*[[Leg edema]]
*[[Leg edema]]
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
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* Infiltrating, ulcerating or fungating lesions in the wall of colon
* Infiltrating, ulcerating or fungating lesions in the wall of colon
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Well-defined single or multiple lesions
* Well-defined single/multiple lesions
* Round or ovoid in shape
* Round/ovoid in shape
* Variable in size ranges between 2-5 cm
* Variable in size between 2-5 cm
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |'''PET scan''' (11C-5-hydroxytryptophan, 11C-5-HTP)
* [[PET scan]] (11C-5-hydroxytryptophan, 11C-5-HTP)
* Detects metastasis
** Detects metastasis
'''MRI'''
* [[MRI]]
* Nodular mass originating from the bowel wall or regional uniform bowel wall thickening
** Nodular mass originating from the bowel wall or regional uniform bowel wall thickening with moderate intense enhancement on post gadolinium T1-weighted fat-suppressed images
* Metastasis
** Mesenteric metastases presents as nodular masses with [[mesenteric]] stranding
'''Ki-67 index'''
** [[Liver]] metastases may show hypointense precontrast T1- and hyperintense T2-weighted images
** [[Liver]] metastases are commonly hypervascular
* Ki-67 index
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Solid or spongy nests of cells accentuated by neatly outlined luminal spaces  
* Solid/spongy nests of cells accentuated by neatly outlined luminal spaces  


* Peripheral nuclear palisading  
* Peripheral nuclear palisading  
* Granular eosinophilic cytoplasm.
* Granular eosinophilic cytoplasm
| style="background: #F5F5F5; padding: 5px;" |[[Biopsy]] and [[Histopathology|histopathological analysis]]
| style="background: #F5F5F5; padding: 5px;" |[[Biopsy]] and [[Histopathology|histopathological analysis]]
|-
|-
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| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| -
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Prolapsing [[polyp]]
* Prolapsing [[polyp]]
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* [[Hypotonia]]
* [[Hypotonia]]
* [[Intestinal obstruction|Bowel obstruction]]
* [[Intestinal obstruction|Bowel obstruction]]
* Heart or brain abnormalities
* [[Heart]] or [[brain]] abnormalities
* Cleft palate
* [[Cleft lip and palate|Cleft palate]]
* Polydactyly
* [[Polydactyly]]
* Abnormalities of the genitalia or urinary tract.
* Genitalia or urinary abnormalities
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
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* Multiple [[Polyps|juvenile polyps]] in [[gastrointestinal tract]]
* Multiple [[Polyps|juvenile polyps]] in [[gastrointestinal tract]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* M[[Polyps|ultiple polyps]] in [[gastrointestinal tract]]
* [[Polyp|Multiple polyps]] in [[gastrointestinal tract|GI tract]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |'''Barium study'''
* Barium study
* Multiple polyps in GI tract
** Multiple polyps in GI tract
'''Stool DNA test'''
* Stool DNA test
* ''SMAD4'' or ''BMPR1A''
** ''SMAD4'' or ''BMPR1A''
'''Diagnose if any of the following positive:'''
* Diagnose if any of the following positive:
* More than five juvenile polyps of the colorectum
** More than five juvenile polyps of the colorectum
* Multiple juvenile polyps throughout the GI tract
** Multiple juvenile polyps throughout the GI tract
* Any number of juvenile polyps and a family history of juvenile polyposis
** Any number of juvenile polyps and a family history of juvenile polyposis
* Heterozygous pathogenic variant in ''SMAD4'' or ''BMPR1A''
** Heterozygous pathogenic variant in ''SMAD4'' or ''BMPR1A''
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Numerous cystic and dilated crypts or glands with inspissated mucin and intraluminal neutrophils
* Numerous cystic and dilated crypts or glands with inspissated mucin and intraluminal neutrophils
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* Filiform, multilobated forms with increased glandular-to-stroma ratio in nonclassic or atypical polyps
* Filiform, multilobated forms with increased glandular-to-stroma ratio in nonclassic or atypical polyps
* Areas of conventional dysplasia
* Areas of conventional dysplasia
| style="background: #F5F5F5; padding: 5px;" |Diagnostic criteria on the basis of history, colonoscopy, and genetics
| style="background: #F5F5F5; padding: 5px;" |Diagnostic criteria fulfilment
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Gastrointestinal stromal tumor|Gastrointestinal Stromal Tumors (GIST)]]<ref name="pmid24778074">{{cite journal |vauthors=Niazi AK, Kaley K, Saif MW |title=Gastrointestinal stromal tumor of colon: a case report and review of literature |journal=Anticancer Res. |volume=34 |issue=5 |pages=2547–50 |date=May 2014 |pmid=24778074 |doi= |url=}}</ref><ref name="pmid247780742">{{cite journal |vauthors=Niazi AK, Kaley K, Saif MW |title=Gastrointestinal stromal tumor of colon: a case report and review of literature |journal=Anticancer Res. |volume=34 |issue=5 |pages=2547–50 |date=May 2014 |pmid=24778074 |doi= |url=}}</ref><ref name="pmid15223958">{{cite journal |vauthors=Medeiros F, Corless CL, Duensing A, Hornick JL, Oliveira AM, Heinrich MC, Fletcher JA, Fletcher CD |title=KIT-negative gastrointestinal stromal tumors: proof of concept and therapeutic implications |journal=Am. J. Surg. Pathol. |volume=28 |issue=7 |pages=889–94 |date=July 2004 |pmid=15223958 |doi= |url=}}</ref><ref name="pmid16222452">{{cite journal |vauthors=Kamiyama Y, Aihara R, Nakabayashi T, Mochiki E, Asao T, Kuwano H, Oriuchi N, Endo K |title=18F-fluorodeoxyglucose positron emission tomography: useful technique for predicting malignant potential of gastrointestinal stromal tumors |journal=World J Surg |volume=29 |issue=11 |pages=1429–35 |date=November 2005 |pmid=16222452 |doi=10.1007/s00268-005-0045-6 |url=}}</ref><ref name="pmid15613856">{{cite journal |vauthors=Miettinen M, Sobin LH, Lasota J |title=Gastrointestinal stromal tumors of the stomach: a clinicopathologic, immunohistochemical, and molecular genetic study of 1765 cases with long-term follow-up |journal=Am. J. Surg. Pathol. |volume=29 |issue=1 |pages=52–68 |date=January 2005 |pmid=15613856 |doi= |url=}}</ref>
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Gastrointestinal stromal tumor|Gastrointestinal Stromal Tumors (GIST)]]<ref name="pmid24778074">{{cite journal |vauthors=Niazi AK, Kaley K, Saif MW |title=Gastrointestinal stromal tumor of colon: a case report and review of literature |journal=Anticancer Res. |volume=34 |issue=5 |pages=2547–50 |date=May 2014 |pmid=24778074 |doi= |url=}}</ref><ref name="pmid247780742">{{cite journal |vauthors=Niazi AK, Kaley K, Saif MW |title=Gastrointestinal stromal tumor of colon: a case report and review of literature |journal=Anticancer Res. |volume=34 |issue=5 |pages=2547–50 |date=May 2014 |pmid=24778074 |doi= |url=}}</ref><ref name="pmid15223958">{{cite journal |vauthors=Medeiros F, Corless CL, Duensing A, Hornick JL, Oliveira AM, Heinrich MC, Fletcher JA, Fletcher CD |title=KIT-negative gastrointestinal stromal tumors: proof of concept and therapeutic implications |journal=Am. J. Surg. Pathol. |volume=28 |issue=7 |pages=889–94 |date=July 2004 |pmid=15223958 |doi= |url=}}</ref><ref name="pmid16222452">{{cite journal |vauthors=Kamiyama Y, Aihara R, Nakabayashi T, Mochiki E, Asao T, Kuwano H, Oriuchi N, Endo K |title=18F-fluorodeoxyglucose positron emission tomography: useful technique for predicting malignant potential of gastrointestinal stromal tumors |journal=World J Surg |volume=29 |issue=11 |pages=1429–35 |date=November 2005 |pmid=16222452 |doi=10.1007/s00268-005-0045-6 |url=}}</ref><ref name="pmid15613856">{{cite journal |vauthors=Miettinen M, Sobin LH, Lasota J |title=Gastrointestinal stromal tumors of the stomach: a clinicopathologic, immunohistochemical, and molecular genetic study of 1765 cases with long-term follow-up |journal=Am. J. Surg. Pathol. |volume=29 |issue=1 |pages=52–68 |date=January 2005 |pmid=15613856 |doi= |url=}}</ref>
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| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| -
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Mostly [[asymptomatic]]
* [[asymptomatic]]
* Are discovered incidentally  
* Discovered incidentally  
* Non-specific symptoms
* [[Satiety|Early satiety]]
* Early satiety and bloating
* [[Bloating]]
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
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* Bulging into [[Gastrointestinal tract|gastrointestinal]] [[lumen]]
* Bulging into [[Gastrointestinal tract|gastrointestinal]] [[lumen]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Small GIST (< 5 cms) are [[homogeneous]] with clear boundaries and have an [[intraluminal]] pattern of growth.
* Small GIST (< 5 cms) are [[homogeneous]] with clear boundaries and[[intraluminal]] growth
* Intermediate GIST (size of 5-10 cms) are [[heterogeneous]] with irregular borders and [[Intraluminal|intra]] or extra-luminal pattern of [[growth]].
* Intermediate GIST (5-10 cms) [[heterogeneous]] with irregular borders and [[Intraluminal|intra]]/extra-luminal [[growth]].
* Large GISTs (>10 cms) are [[heterogeneous]] with irregular borders and have local or distant spread
* Large GISTs (>10 cms) [[heterogeneous]] with irregular borders and local/distant spread
* Malignant GIST with metastasis:
* Malignant GIST with metastasis:
** Size greater than 10 cm
** Size > 10 cm
** [[Calcification|Calcifications]]
** [[Calcification|Calcifications]]
** Irregular margins
** Irregular margins
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** Extraluminal and [[mesenteric]] fat infiltration
** Extraluminal and [[mesenteric]] fat infiltration
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[MRI]]
 
** [[Hemorrhage]], [[necrosis]], surrounding structures and [[metastasis]].
'''[[Endoscopic ultrasound|Endoscopic]] [[ultrasonography]]'''
* [[Endoscopic ultrasound|Endoscopic]] [[ultrasonography]]:
 
** [[Mucosal]] [[ulceration]] or [[bleeding]]
Benign:
** Smooth [[submucosal]] mass as hypoechoic mass
* [[Mucosal]] [[ulceration]] or [[bleeding]]
** [[Malignant]] GIST lesions present with:
* Smooth [[submucosal]] mass as hypoechoic mass
*** [[Heterogeneous]] mass >4 cm in size
[[Malignant]] GIST:
*** Irregular borders
* [[Heterogeneous]] mass >4 cm in size
*** [[Intraluminal|Intra]] and extraluminal growth
* Irregular borders
*** Multiple [[cysts]] within the main [[lesion]]
* [[Intraluminal|Intra]]/extraluminal growth
* Multiple [[cysts]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
*[[Spindle cells|Spindle cell]] type are [[eosinophilic]] cells arranged in the form of whorls or fascicles.<ref name="pmid12075401">{{cite journal |vauthors=Fletcher CD, Berman JJ, Corless C, Gorstein F, Lasota J, Longley BJ, Miettinen M, O'Leary TJ, Remotti H, Rubin BP, Shmookler B, Sobin LH, Weiss SW |title=Diagnosis of gastrointestinal stromal tumors: a consensus approach |journal=Int. J. Surg. Pathol. |volume=10 |issue=2 |pages=81–9 |date=April 2002 |pmid=12075401 |doi=10.1177/106689690201000201 |url=}}</ref><ref name="pmid120754012">{{cite journal |vauthors=Fletcher CD, Berman JJ, Corless C, Gorstein F, Lasota J, Longley BJ, Miettinen M, O'Leary TJ, Remotti H, Rubin BP, Shmookler B, Sobin LH, Weiss SW |title=Diagnosis of gastrointestinal stromal tumors: a consensus approach |journal=Int. J. Surg. Pathol. |volume=10 |issue=2 |pages=81–9 |date=April 2002 |pmid=12075401 |doi=10.1177/106689690201000201 |url=}}</ref>
*[[Spindle cells|Spindle cell]] type are [[eosinophilic]] cells arranged in the form of whorls or fascicles.<ref name="pmid12075401">{{cite journal |vauthors=Fletcher CD, Berman JJ, Corless C, Gorstein F, Lasota J, Longley BJ, Miettinen M, O'Leary TJ, Remotti H, Rubin BP, Shmookler B, Sobin LH, Weiss SW |title=Diagnosis of gastrointestinal stromal tumors: a consensus approach |journal=Int. J. Surg. Pathol. |volume=10 |issue=2 |pages=81–9 |date=April 2002 |pmid=12075401 |doi=10.1177/106689690201000201 |url=}}</ref><ref name="pmid120754012">{{cite journal |vauthors=Fletcher CD, Berman JJ, Corless C, Gorstein F, Lasota J, Longley BJ, Miettinen M, O'Leary TJ, Remotti H, Rubin BP, Shmookler B, Sobin LH, Weiss SW |title=Diagnosis of gastrointestinal stromal tumors: a consensus approach |journal=Int. J. Surg. Pathol. |volume=10 |issue=2 |pages=81–9 |date=April 2002 |pmid=12075401 |doi=10.1177/106689690201000201 |url=}}</ref>
*[[Epithelioid]] [[GIST|GISTs]] are rounded cells with oval nuclei and vesicular chromatin and appears nested
*[[Epithelioid]] [[GIST|GISTs]] are rounded cells with oval nuclei and vesicular chromatin and appears nested
*On [[immunohistochemical staining]] they are positive for [[Molecular marker|molecular markers]] [[CD117]] antigen and KIT protein.
*On [[immunohistochemical staining]] they are positive for [[Molecular marker|molecular markers]] [[CD117]] antigen and KIT protein.
| style="background: #F5F5F5; padding: 5px;" |Endoscopic ultrasound with [[biopsy]] and [[Histopathological|histopathological analysis]]
| style="background: #F5F5F5; padding: 5px;" |Endoscopic ultrasound
[[biopsy]] and [[Histopathological|histopathological analysis]]
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Hamartoma]]<ref name="pmid26672891">{{cite journal |vauthors=Cauchin E, Touchefeu Y, Matysiak-Budnik T |title=Hamartomatous Tumors in the Gastrointestinal Tract |journal=Gastrointest Tumors |volume=2 |issue=2 |pages=65–74 |date=September 2015 |pmid=26672891 |pmc=4668787 |doi=10.1159/000437175 |url=}}</ref>
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Hamartoma]]<ref name="pmid26672891">{{cite journal |vauthors=Cauchin E, Touchefeu Y, Matysiak-Budnik T |title=Hamartomatous Tumors in the Gastrointestinal Tract |journal=Gastrointest Tumors |volume=2 |issue=2 |pages=65–74 |date=September 2015 |pmid=26672891 |pmc=4668787 |doi=10.1159/000437175 |url=}}</ref>
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| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[Tenesmus]]
* N/A
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Large polypoid mass
* Large polypoid mass
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Isodense or hypodense solid [[Mass|masses]]
* Isodense/hypodense solid [[Mass|masses]]
* [[Heterogeneous]] mass
* [[Heterogeneous]] mass
* Presence of [[fat]] in a well circumscribed nodule
* Presence of [[fat]]
* [[Calcification]]
* [[Calcification]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |'''Biopsy'''
* Biopsy
* Proliferation of bland spindle cells in the lamina propria  
** Proliferation of bland spindle cells in the lamina propria (mucosal Schwann cell hamartoma (MSCH))
* mucosal Schwann cell hamartoma (MSCH))
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* poorly circumscribed, short fascicles of uniform spindle cells replacing the colonic lamina propria, separating and entrapping the crypts
* poorly circumscribed, short fascicles of uniform spindle cells replacing the colonic lamina propria, separating and entrapping the crypts
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| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" | +/-
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| -
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Weight loss
* [[Weight loss]]
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Polypoid or ulcerated mass, intramural lesion, aphthous ulcer, stricture, extraluminal mass, or diffuse, multiple polypoid lesions
* Polypoid or ulcerated mass, intramural lesion, aphthous ulcer, stricture, extraluminal mass, or diffuse, multiple polypoid lesions
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* CT scan: polypoid mass, circumferential-cavitary lesions, focal mucosal nodularity, diffuse ulcerative or nodular lesions, regional lymph node involvement
* Polypoid mass
| style="background: #F5F5F5; padding: 5px;" |
* Circumferential-cavitary lesions
* Biopsy:  
* Focal mucosal nodularity
** [[Diffuse large B cell lymphoma|Diffuse large B-cell lymphoma]]
* Diffuse ulcerative or nodular lesions
** [[MALT lymphoma|Extranodal marginal zone lymphoma (MALT)]]
* [[Lymphadenopathy]]
** [[Mantle cell lymphoma]]
| style="background: #F5F5F5; padding: 5px;" |'''Biopsy:'''
** [[Burkitt's lymphoma|Burkitt’s lymphoma]]
* [[Diffuse large B cell lymphoma|Diffuse large B-cell lymphoma]]
** [[Follicular lymphoma]]
* [[MALT lymphoma|Extranodal marginal zone lymphoma (MALT)]]
* Double-contrast enema: Subtle mucosal changes, gross tumor morphology
* [[Mantle cell lymphoma]]
* [[Burkitt's lymphoma|Burkitt’s lymphoma]]
* [[Follicular lymphoma]]
'''Double-contrast enema'''
* Subtle mucosal changes
* Gross tumor morphology
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[Diffuse large B cell lymphoma|Diffuse large B-cell lymphoma]]:  
* [[Diffuse large B cell lymphoma|Diffuse large B-cell lymphoma]]:  
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| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| -
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[Melena]]
* [[Hematochezia]]
* [[Abdominal pain]]
* [[Nausea and vomiting|N/V]]
* [[Nausea and vomiting|N/V]]
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
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| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* N/A
* N/A
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |'''Serology'''
* Electrophoresis
* [[Antibodies]] against Kaposi sarcoma herpes virus  (HHV-8)
** [[Antibodies]] against Kaposi sarcoma herpes virus  (HHV-8)
'''Biopsy'''
* Biopsy
* [[Vascular]] proliferation, red blood cell and [[hemosiderin]]
** [[Vascular]] proliferation, red blood cell and [[hemosiderin]] extravasation,[[Lymphocyte|lymphocytes]] and [[Monocyte|monocytes]], neovascular lesion wrapped around a pre-existing space, intracytoplasmic PAS +ve [[hyaline]] globules
* Extravasation,[[Lymphocyte|lymphocytes]] and [[Monocyte|monocytes]]
* Neovascular lesion wrapped around a pre-existing space
* Intracytoplasmic PAS +ve [[hyaline]] globules
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[Vascular]] proliferation
* [[Vascular]] proliferation
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| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| -
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* N/A
* N/A
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| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* N/A
* N/A
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |N/A
* N/A
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Aberrant vessels with thickened, hypertrophic walls in the mucosa and the submucosa.
* Aberrant vessels with thickened, hypertrophic walls in the mucosa and the submucosa.
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RLQ
RLQ
| -
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[Fever]], [[Rigor|chills]]
* [[Fever]]
* [[Nausea and vomiting|Nausea/vomiting(N/V)]]
* [[Rigor|Chills]]
* [[Nausea and vomiting|N/V]]
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
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* Abscess formation
* Abscess formation
* Intraperitoneal free air (microperforation)
* Intraperitoneal free air (microperforation)
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |'''Barium enema'''
* Barium enema: Circumferential narrowing, spiculated contour and tapered margins  
* Circumferential narrowing
* Spiculated contour
* Tapered margins
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* N/A
* N/A
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| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| -
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Perianal Itching
* Perianal Itching
* Pain with [[defecation]]  
* Pain with [[defecation]]  
* Painful, hard lump in anus
* Painful-hard lump in anus
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
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| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* N/A
* N/A
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |'''DRE'''
* [[Digital rectal examination|DRE]]
* Palpable mass, tender if [[Thrombosis|thrombosed]]
** Palpable mass, tender if [[Thrombosis|thrombosed]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* N/A
* N/A
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| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| -
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Painful [[defecation]]
* [[Dyschezia|Painful defecation]]
* [[Itching]]
* [[Itching]]
* [[Irritation]]
* [[Irritation]]
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| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* N/A
* N/A
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |N/A
* N/A
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* N/A
* N/A
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| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| -
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[Fever]], [[Rigor|chills]]
* [[Fever]], [[Rigor|chills]]
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| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* N/A
* N/A
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |'''Stool cultures'''
* [[Stool culture|Stool cultures]] in adequate [[culture media]]
 
* Stool analysis
'''Stool analysis'''
** [[Leukocytosis]]
* [[Leukocytosis]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* N/A
* N/A
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LLQ
LLQ
| +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[Diarrhea]] with blood and [[mucus]]
* [[Weight loss|Weight loss]]
* [[Weight loss|Weight loss]]
* Diarrhea with[[mucus]]
* Urgency
* Urgency
* [[Tenesmus]]
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
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| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* N/A
* N/A
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |N/A
* N/A
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Mucosal and submucosal inflammation
* Mucosal and submucosal inflammation
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* Distorted crypts
* Distorted crypts
* Crypt abscess
* Crypt abscess
| style="background: #F5F5F5; padding: 5px;" |Endoscopy and a mucosal biopsy
| style="background: #F5F5F5; padding: 5px;" |Endoscopic biopsy
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Crohn's disease]]<ref name="pmid25075198">{{cite journal |vauthors=Fakhoury M, Negrulj R, Mooranian A, Al-Salami H |title=Inflammatory bowel disease: clinical aspects and treatments |journal=J Inflamm Res |volume=7 |issue= |pages=113–20 |date=2014 |pmid=25075198 |pmc=4106026 |doi=10.2147/JIR.S65979 |url=}}</ref>
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Crohn's disease]]<ref name="pmid25075198">{{cite journal |vauthors=Fakhoury M, Negrulj R, Mooranian A, Al-Salami H |title=Inflammatory bowel disease: clinical aspects and treatments |journal=J Inflamm Res |volume=7 |issue= |pages=113–20 |date=2014 |pmid=25075198 |pmc=4106026 |doi=10.2147/JIR.S65979 |url=}}</ref>
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LRQ
LRQ
 
| +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[Tenesmus]]
* [[Nausea and vomiting|N/V]]
* [[Nausea and vomiting|N/V]]
* [[Bowel obstruction]]
* [[Bowel obstruction]]
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| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* N/A
* N/A
| style="background: #F5F5F5; padding: 5px;" |N/A
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* N/A
* Transmural pattern of [[inflammation]]
| style="background: #F5F5F5; padding: 5px;" |
* [[Mucous membrane|Mucosal]] damage
* Transmural pattern of inflammation
* Mucosal damage
* Focal infiltration of leukocytes into the epithelium
* Focal infiltration of leukocytes into the epithelium
* Granulomas
* Granulomas
| style="background: #F5F5F5; padding: 5px;" |Endoscopy and a mucosal biopsy
| style="background: #F5F5F5; padding: 5px;" |Endoscopic biopsy
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Irritable bowel syndrome]]<ref name="pmid28875974">{{cite journal |vauthors=Iwańczak B, Iwańczak F |title=[Functional gastrointestinal disorders in children and adolescents. The Rome IV criteria] |language=Polish |journal=Pol. Merkur. Lekarski |volume=43 |issue=254 |pages=75–82 |date=August 2017 |pmid=28875974 |doi= |url=}}</ref>
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Irritable bowel syndrome]]<ref name="pmid28875974">{{cite journal |vauthors=Iwańczak B, Iwańczak F |title=[Functional gastrointestinal disorders in children and adolescents. The Rome IV criteria] |language=Polish |journal=Pol. Merkur. Lekarski |volume=43 |issue=254 |pages=75–82 |date=August 2017 |pmid=28875974 |doi= |url=}}</ref>
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| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Straining during [[defecation]]
* [[Weight loss]]
* Straining
* [[Urgency]]
* [[Urgency]]
* Sensation of incomplete evacuation
* [[Mucus]] passage
* [[Mucus]] passage
* [[Bloating]]
* [[Bloating]]
* Weight loss
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
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| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* N/A
* N/A
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |'''Diagnosis of exclusion'''
* Diagnosis of exclusion with fulfilment of [[Irritable bowel syndrome diagnostic criteria|Rome criteria]]
* Fulfilment of [[Irritable bowel syndrome diagnostic criteria|Rome criteria]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* N/A
* N/A
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| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +


RLQ
[[Right lower quadrant abdominal pain resident survival guide|RLQ]]
| -
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Pain starting periumbilical before localizing to the [[right iliac fossa]]
* Pain starting periumbilical before localizing to the [[Right lower quadrant abdominal pain resident survival guide|RLQ]]
* [[Nausea and vomiting|N/V]]
* [[Nausea and vomiting|N/V]]
* [[Fever]], [[Rigor|chills]]
* [[Fever]]
* [[Rigor|Chills]]
* [[Anorexia|Loss of appetite]]
* [[Anorexia|Loss of appetite]]
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
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* N/A
* N/A
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Appendiceal wall thickening (wall ≥ 3mm)
* [[Appendicitis CT|Appendiceal]] wall thickening (≥ 3mm)
* Periappendiceal fat stranding
* Periappendiceal fat stranding
* Thickening of the [[Fascia|lateral conal fascia]] and [[mesoappendix]]
* Thick [[Fascia|lateral conal fascia]] and [[mesoappendix]]
* Extraluminal fluid
* Extraluminal fluid
* [[Phlegmon]]
* [[Phlegmon]]
* [[Abscess]]
* [[Abscess]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Tc-99m labeled anti-CD15 antibodies
 
* Ultrasound
'''Ultrasound'''
** Aperistaltic, noncompressible, dilated appendix (>6 mm outer diameter)
* Aperistaltic, noncompressible, dilated [[Appendicitis ultrasound|appendix]] (>6 mm)
** [[Appendicolith]]
* [[Appendicolith]]
** Echogenic prominent pericaecal fat
* Echogenic prominent pericaecal fat
** Periappeniceal fluid collection
* Periappendiceal fluid collection
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* N/A
* N/A
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[[Right lower quadrant abdominal pain resident survival guide|RLQ]]
[[Right lower quadrant abdominal pain resident survival guide|RLQ]]
| style="background: #F5F5F5; padding: 5px;" |[[Nausea and vomiting|N/V]]
| -
 
| style="background: #F5F5F5; padding: 5px;" |
Heaviness or dull discomfort in the groin, with straining, lifting, coughing, or exercising
* [[Nausea and vomiting|N/V]]
 
* Heaviness/dull discomfort in the groin, with straining, lifting, coughing, or exercising
Weakness, heaviness, burning, or aching in the groin
* Weakness, heaviness, burning, or aching in the groin
 
* [[swelling]]
Pain and [[swelling]]  
* [[Fever]]
 
[[Fever]]


| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
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| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Defect in the abdominal wall muscles
* Defect in the abdominal wall muscles
* Appearance of bowel loops within the lesion
* Bowel loops within the lesion
* Lateral crescent sign
* Lateral crescent sign
* The hernia neck will be superolateral to the course of the inferior [[epigastric]] vessels.
* The hernia neck superolateral to the course of the inferior [[epigastric]] vessels
* Ultrasound:
** Hypoechoic mass suggesting dilated and edematous intestinal segment
*
*
| style="background: #F5F5F5; padding: 5px;" |'''Ultrasound:'''
* Hypoechoic mass suggesting dilated and edematous intestinal segment
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* N/A
* N/A
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |[[Ultrasound]]
* N/A
| style="background: #F5F5F5; padding: 5px;" |Ultrasound
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Endometriosis|Bowel endometriosis]]<ref name="pmid25400445">{{cite journal |vauthors=Wolthuis AM, Meuleman C, Tomassetti C, D'Hooghe T, de Buck van Overstraeten A, D'Hoore A |title=Bowel endometriosis: colorectal surgeon's perspective in a multidisciplinary surgical team |journal=World J. Gastroenterol. |volume=20 |issue=42 |pages=15616–23 |date=November 2014 |pmid=25400445 |pmc=4229526 |doi=10.3748/wjg.v20.i42.15616 |url=}}</ref>
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Endometriosis|Bowel endometriosis]]<ref name="pmid25400445">{{cite journal |vauthors=Wolthuis AM, Meuleman C, Tomassetti C, D'Hooghe T, de Buck van Overstraeten A, D'Hoore A |title=Bowel endometriosis: colorectal surgeon's perspective in a multidisciplinary surgical team |journal=World J. Gastroenterol. |volume=20 |issue=42 |pages=15616–23 |date=November 2014 |pmid=25400445 |pmc=4229526 |doi=10.3748/wjg.v20.i42.15616 |url=}}</ref>
| style="background: #F5F5F5; padding: 5px;" |↑ or ↓
| style="background: #F5F5F5; padding: 5px;" |↑ or ↓
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |Pelvic
| style="background: #F5F5F5; padding: 5px;" |[[Pelvic pain|Pelvic]]
| +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Dyschezia
* [[Dyschezia]]
* Tenesmus
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
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| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* N/A
* N/A
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |'''Transvaginal ultrasound'''
* Transvaginal ultrasonography
* Heterogeneous, hypoechoic, spiculated mass
** Heterogeneous, hypoechoic, spiculated mass
'''T1-weighted or fat-suppression T1-weighted MRIs'''
* Barium enema
* Contrast enhanced mass  
** Extrinsic mass compressing the bowel, fine crenulation of the mucosa, bowel strictures at the rectosigmoid junction
* Hyperintense hemorrhagic  
* T1-weighted or fat-suppression T1-weighted MRIs
* Hyperintense cavities  
** Contrast enhanced mass or hyperintense foci, hemorrhagic foci or hyperintense cavities  
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* N/A
* N/A
| style="background: #F5F5F5; padding: 5px;" |Transvaginal ultrasonography
| style="background: #F5F5F5; padding: 5px;" |[[Gynecologic ultrasonography|Transvaginal ultrasound]]
|}
|}


Revision as of 18:27, 25 January 2019

Colorectal cancer Microchapters

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To view the differential diagnosis of familial adenomatous polyposis (FAP), click here
To view the differential diagnosis of hereditary nonpolyposis colorectal cancer (HNPCC), click here

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]: Associate Editor(s)-in-Chief: Trusha Tank, M.D.[2], Qurrat-ul-ain Abid, M.D.[3]

Overview

Colorectal cancer must be differentiated from other diseases that cause unexplained weight loss, unexplained loss of appetite, nausea, vomiting, diarrhea, anemia, jaundice, and fatigue, such as irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), hemorrhoids, anal fissures, and diverticular disease. There are less common conditions that may be confused as colorectal cancer such as infectious colitis and gastrointestinal lymphoma.

Colorectal Cancer Differential Diagnosis

Other conditions that can be mistaken for colorectal cancer include the following:

Diseases Clinical manifestations Para-clinical findings Gold standard
Symptoms
Lab Findings Imaging Histopathology
Bowel frequency Blood in stool Abdominal pain Tenesmus Other symptoms Anemia Colonoscopy CT scan Other diagnostic study
Adenocarcinoma[7] ↑ or ↓ + +/- + + PET scans
  • Detailed images and metastasis

Barium enema

  • Cancer or a precancerous polyp

Genetic testing

  • Different grades of differentiation of glandular structures
    • Sheets or cords of malignant cells,
    • Cellular atypia, pleomorphism
    • High mitotic rate
  • Necrotic debris in glandular lumina
  • Desmoplastic reaction (sign of invasion)
 Biopsy and histopathological analysis
Peutz-Jeghers syndrome
[8][9][10][11][12] 		↑ or ↓ + + - + Barium enema

MRI

Genetic testing for STK11 and colonoscopy
Carcinoids
[13][14][15][16][17] 		↑ +/- + - +
  • Infiltrating, ulcerating or fungating lesions in the wall of colon
  • Well-defined single/multiple lesions
  • Round/ovoid in shape
  • Variable in size between 2-5 cm
 PET scan (11C-5-hydroxytryptophan, 11C-5-HTP)
  • Detects metastasis

MRI

  • Nodular mass originating from the bowel wall or regional uniform bowel wall thickening
  • Metastasis

Ki-67 index

  • Solid/spongy nests of cells accentuated by neatly outlined luminal spaces
  • Peripheral nuclear palisading
  • Granular eosinophilic cytoplasm
 Biopsy and histopathological analysis
Juvenile Polyposis Coli[18][19][20][21][22] ↑ + + - + Barium study
  • Multiple polyps in GI tract

Stool DNA test

  • SMAD4 or BMPR1A

Diagnose if any of the following positive:

  • More than five juvenile polyps of the colorectum
  • Multiple juvenile polyps throughout the GI tract
  • Any number of juvenile polyps and a family history of juvenile polyposis
  • Heterozygous pathogenic variant in SMAD4 or BMPR1A
  • Numerous cystic and dilated crypts or glands with inspissated mucin and intraluminal neutrophils
  • Lamina propria edematous with associated lymphocytes, plasma cells, eosinophils and neutrophils
  • Filiform, multilobated forms with increased glandular-to-stroma ratio in nonclassic or atypical polyps
  • Areas of conventional dysplasia
 Diagnostic criteria fulfilment
Gastrointestinal Stromal Tumors (GIST)[23][24][25][26][27] - +/- - - +/-

Endoscopic ultrasonography

Benign:

Malignant GIST:

Endoscopic ultrasound

biopsy and histopathological analysis

Hamartoma[30] ↑ + + +
  • N/A
 -
  • Large polypoid mass
 Biopsy
  • Proliferation of bland spindle cells in the lamina propria
  • mucosal Schwann cell hamartoma (MSCH))
  • poorly circumscribed, short fascicles of uniform spindle cells replacing the colonic lamina propria, separating and entrapping the crypts
  • The nuclei are bland and mostly uniform, occasional larger nuclei are found. The cytoplasmic borders are indistinct
  • Involvement of mucosa but never the submucosa
 Biopsy
Colorectal Lymphoma[31][32] - +/- + - +
  • Polypoid or ulcerated mass, intramural lesion, aphthous ulcer, stricture, extraluminal mass, or diffuse, multiple polypoid lesions
  • Polypoid mass
  • Circumferential-cavitary lesions
  • Focal mucosal nodularity
  • Diffuse ulcerative or nodular lesions
  • Lymphadenopathy
 Biopsy:

Double-contrast enema

  • Subtle mucosal changes
  • Gross tumor morphology
 Biopsy
Kaposi's sarcoma[33] ↑ + + - +
  • Localized purpuric lesion
  • N/A
 Serology
  • Antibodies against Kaposi sarcoma herpes virus (HHV-8)

Biopsy

Biopsy
Arteriovenous malformation[34] - + - -
  • N/A
 +
  • Bright red, flat lesions
  • Rarely, polypoid
  • N/A
 N/A
  • Aberrant vessels with thickened, hypertrophic walls in the mucosa and the submucosa.
  • Arteries directly connected to veins without capillary beds
 Accidental finding
Diverticular diseases[35][36][37] ↑ or ↓ +/- +

RLQ

- -
  • Not recommended
  • Outpouchings of the colonic wall (Diverticula)
  • Inflamed diverticula
  • Abscess formation
  • Intraperitoneal free air (microperforation)
 Barium enema
  • Circumferential narrowing
  • Spiculated contour
  • Tapered margins
  • N/A
 CT scan
Hemorrhoids[38] ↓ + + -
  • Perianal Itching
  • Pain with defecation
  • Painful-hard lump in anus
 +
  • N/A
 DRE
  • N/A
 Clinical
Anal fissure[39] - + + - +/-
  • N/A
 N/A
  • N/A
 Clinical
Infectious colitis[40] ↑ + + - -
  • N/A
 Stool cultures

Stool analysis

  • N/A
 Stool culture
Ulcerative colitis[41]V ↑ + +

LLQ

+ +
  • N/A
 N/A
  • Mucosal and submucosal inflammation
  • Hemorrhage or inflammatory polymorphonuclear cells aggregate in the lamina propria
  • Distorted crypts
  • Crypt abscess
 Endoscopic biopsy
Crohn's disease[41] ↑ + +

LRQ

+ +
  • Discontinuous lesions
  • Strictures
  • Linear ulcerations
  • N/A
 N/A
  • Transmural pattern of inflammation
  • Mucosal damage
  • Focal infiltration of leukocytes into the epithelium
  • Granulomas
 Endoscopic biopsy
Irritable bowel syndrome[42] ↑ ↓ + + + -
  • Not recommended
  • N/A
 Diagnosis of exclusion
  • N/A
 Clinical diagnosis (Rome criteria)
Appendicitis[43] ↑ - +

RLQ

- -
  • N/A

Ultrasound

  • Aperistaltic, noncompressible, dilated appendix (>6 mm)
  • Appendicolith
  • Echogenic prominent pericaecal fat
  • Periappendiceal fluid collection
  • N/A
 CT scan
Strangulated hernia ↓ - +

RLQ

-
  • N/V
  • Heaviness/dull discomfort in the groin, with straining, lifting, coughing, or exercising
  • Weakness, heaviness, burning, or aching in the groin
  • swelling
  • Fever
 -
  • N/A
  • Defect in the abdominal wall muscles
  • Bowel loops within the lesion
  • Lateral crescent sign
  • The hernia neck superolateral to the course of the inferior epigastric vessels
 Ultrasound:
  • Hypoechoic mass suggesting dilated and edematous intestinal segment
  • N/A
 Ultrasound
Bowel endometriosis[44] ↑ or ↓ + Pelvic + +
  • N/A
  • N/A
 Transvaginal ultrasound
  • Heterogeneous, hypoechoic, spiculated mass

T1-weighted or fat-suppression T1-weighted MRIs

  • Contrast enhanced mass
  • Hyperintense hemorrhagic
  • Hyperintense cavities
  • N/A
 Transvaginal ultrasound

References

  1. ↑ Laurell H, Hansson LE, Gunnarsson U (2007). "Acute diverticulitis--clinical presentation and differential diagnostics". Colorectal Dis. 9 (6): 496–501, discussion 501-2. doi:10.1111/j.1463-1318.2006.01162.x. PMID 17573742.
  2. ↑ Hardin, M. Acute Appendicitis: Review and Update. Am Fam Physician".1999, Nov 1;60(7):2027-2034
  3. ↑ Hanauer SB (1996). "Inflammatory bowel disease". N Engl J Med. 334 (13): 841–8. doi:10.1056/NEJM199603283341307. PMID 8596552.
  4. ↑ Cystitis-acute. MedlinePlus.https://www.nlm.nih.gov/medlineplus/ency/article/000526.htm Accessed on February 9, 2016
  5. ↑ Prostatitis - bacterial. NLM Medline Plus 2016. https://www.nlm.nih.gov/medlineplus/ency/article/000519.htm. Accessed on March 2, 2016
  6. ↑ Ford GW, Decker CF (2016). "Pelvic inflammatory disease". Dis Mon. 62 (8): 301–5. doi:10.1016/j.disamonth.2016.03.015. PMID 27107781.
  7. ↑ Secco GB, Fardelli R, Campora E, Lapertosa G, Gentile R, Zoli S, Prior C (1994). "Primary mucinous adenocarcinomas and signet-ring cell carcinomas of colon and rectum". Oncology. 51 (1): 30–4. doi:10.1159/000227306. PMID 8265100.
  8. ↑ Zhong ME, Niu BZ, Ji WY, Wu B (June 2016). "Laparoscopic restorative proctocolectomy with ileal pouch-anal anastomosis for Peutz-Jeghers syndrome with synchronous rectal cancer". World J. Gastroenterol. 22 (22): 5293–6. doi:10.3748/wjg.v22.i22.5293. PMID 27298573.
  9. ↑ Kopacova, Marcela; Tacheci, Ilja; Rejchrt, Stanislav; Bures, Jan (2009). "Peutz-Jeghers syndrome: Diagnostic and therapeuticapproach". World Journal of Gastroenterology. 15 (43): 5397. doi:10.3748/wjg.15.5397. ISSN 1007-9327.
  10. ↑ Giardiello, F; Trimbath, J (2006). "Peutz-Jeghers Syndrome and Management Recommendations". Clinical Gastroenterology and Hepatology. 4 (4): 408–415. doi:10.1016/j.cgh.2005.11.005. ISSN 1542-3565.
  11. ↑ Beggs, A. D.; Latchford, A. R.; Vasen, H. F. A.; Moslein, G.; Alonso, A.; Aretz, S.; Bertario, L.; Blanco, I.; Bulow, S.; Burn, J.; Capella, G.; Colas, C.; Friedl, W.; Moller, P.; Hes, F. J.; Jarvinen, H.; Mecklin, J.-P.; Nagengast, F. M.; Parc, Y.; Phillips, R. K. S.; Hyer, W.; Ponz de Leon, M.; Renkonen-Sinisalo, L.; Sampson, J. R.; Stormorken, A.; Tejpar, S.; Thomas, H. J. W.; Wijnen, J. T.; Clark, S. K.; Hodgson, S. V. (2010). "Peutz-Jeghers syndrome: a systematic review and recommendations for management". Gut. 59 (7): 975–986. doi:10.1136/gut.2009.198499. ISSN 0017-5749.
  12. ↑ Kopacova, Marcela; Tacheci, Ilja; Rejchrt, Stanislav; Bures, Jan (2009). "Peutz-Jeghers syndrome: Diagnostic and therapeuticapproach". World Journal of Gastroenterology. 15 (43): 5397. doi:10.3748/wjg.15.5397. ISSN 1007-9327.
  13. ↑ Chung TP, Hunt SR (May 2006). "Carcinoid and neuroendocrine tumors of the colon and rectum". Clin Colon Rectal Surg. 19 (2): 45–8. doi:10.1055/s-2006-942343. PMC 2780103. PMID 20011309.
  14. ↑ Diagnostics: Biochemical Markers, Imaging, and Approach. National cancer institute. http://www.cancer.gov/types/gi-carcinoid-tumors/hp/gi-carcinoid-treatment-pdq
  15. ↑ Rindi G, Falconi M, Klersy C, Albarello L, Boninsegna L, Buchler MW, Capella C, Caplin M, Couvelard A, Doglioni C, Delle Fave G, Fischer L, Fusai G, de Herder WW, Jann H, Komminoth P, de Krijger RR, La Rosa S, Luong TV, Pape U, Perren A, Ruszniewski P, Scarpa A, Schmitt A, Solcia E, Wiedenmann B (May 2012). "TNM staging of neoplasms of the endocrine pancreas: results from a large international cohort study". J. Natl. Cancer Inst. 104 (10): 764–77. doi:10.1093/jnci/djs208. PMID 22525418.
  16. ↑ Fang C, Wang W, Zhang Y, Feng X, Sun J, Zeng Y, Chen Y, Li Y, Chen M, Zhou Z, Chen J (June 2017). "Clinicopathologic characteristics and prognosis of gastroenteropancreatic neuroendocrine neoplasms: a multicenter study in South China". Chin J Cancer. 36 (1): 51. doi:10.1186/s40880-017-0218-3. PMC 5480192. PMID 28637502.
  17. ↑ Signs and symptoms of carcinoid syndrome. National Cancer Institute. http://www.cancer.gov/types/gi-carcinoid-tumors/patient/gi-carcinoid-treatment-pdq
  18. ↑ Grotsky HW, Rickert RR, Smith WD, Newsome JF (March 1982). "Familial juvenile polyposis coli. A clinical and pathologic study of a large kindred". Gastroenterology. 82 (3): 494–501. PMID 7054044.
  19. ↑ Brosens LA, Langeveld D, van Hattem WA, Giardiello FM, Offerhaus GJ (November 2011). "Juvenile polyposis syndrome". World J. Gastroenterol. 17 (44): 4839–44. doi:10.3748/wjg.v17.i44.4839. PMC 3235625. PMID 22171123.
  20. ↑ Latchford AR, Neale K, Phillips RK, Clark SK (October 2012). "Juvenile polyposis syndrome: a study of genotype, phenotype, and long-term outcome". Dis. Colon Rectum. 55 (10): 1038–43. doi:10.1097/DCR.0b013e31826278b3. PMID 22965402.
  21. ↑ Latchford AR, Neale K, Phillips RK, Clark SK (October 2012). "Juvenile polyposis syndrome: a study of genotype, phenotype, and long-term outcome". Dis. Colon Rectum. 55 (10): 1038–43. doi:10.1097/DCR.0b013e31826278b3. PMID 22965402.
  22. ↑ Latchford AR, Neale K, Phillips RK, Clark SK (October 2012). "Juvenile polyposis syndrome: a study of genotype, phenotype, and long-term outcome". Dis. Colon Rectum. 55 (10): 1038–43. doi:10.1097/DCR.0b013e31826278b3. PMID 22965402.
  23. ↑ Niazi AK, Kaley K, Saif MW (May 2014). "Gastrointestinal stromal tumor of colon: a case report and review of literature". Anticancer Res. 34 (5): 2547–50. PMID 24778074.
  24. ↑ Niazi AK, Kaley K, Saif MW (May 2014). "Gastrointestinal stromal tumor of colon: a case report and review of literature". Anticancer Res. 34 (5): 2547–50. PMID 24778074.
  25. ↑ Medeiros F, Corless CL, Duensing A, Hornick JL, Oliveira AM, Heinrich MC, Fletcher JA, Fletcher CD (July 2004). "KIT-negative gastrointestinal stromal tumors: proof of concept and therapeutic implications". Am. J. Surg. Pathol. 28 (7): 889–94. PMID 15223958.
  26. ↑ Kamiyama Y, Aihara R, Nakabayashi T, Mochiki E, Asao T, Kuwano H, Oriuchi N, Endo K (November 2005). "18F-fluorodeoxyglucose positron emission tomography: useful technique for predicting malignant potential of gastrointestinal stromal tumors". World J Surg. 29 (11): 1429–35. doi:10.1007/s00268-005-0045-6. PMID 16222452.
  27. ↑ Miettinen M, Sobin LH, Lasota J (January 2005). "Gastrointestinal stromal tumors of the stomach: a clinicopathologic, immunohistochemical, and molecular genetic study of 1765 cases with long-term follow-up". Am. J. Surg. Pathol. 29 (1): 52–68. PMID 15613856.
  28. ↑ Fletcher CD, Berman JJ, Corless C, Gorstein F, Lasota J, Longley BJ, Miettinen M, O'Leary TJ, Remotti H, Rubin BP, Shmookler B, Sobin LH, Weiss SW (April 2002). "Diagnosis of gastrointestinal stromal tumors: a consensus approach". Int. J. Surg. Pathol. 10 (2): 81–9. doi:10.1177/106689690201000201. PMID 12075401.
  29. ↑ Fletcher CD, Berman JJ, Corless C, Gorstein F, Lasota J, Longley BJ, Miettinen M, O'Leary TJ, Remotti H, Rubin BP, Shmookler B, Sobin LH, Weiss SW (April 2002). "Diagnosis of gastrointestinal stromal tumors: a consensus approach". Int. J. Surg. Pathol. 10 (2): 81–9. doi:10.1177/106689690201000201. PMID 12075401.
  30. ↑ Cauchin E, Touchefeu Y, Matysiak-Budnik T (September 2015). "Hamartomatous Tumors in the Gastrointestinal Tract". Gastrointest Tumors. 2 (2): 65–74. doi:10.1159/000437175. PMC 4668787. PMID 26672891.
  31. ↑ Quayle FJ, Lowney JK (May 2006). "Colorectal lymphoma". Clin Colon Rectal Surg. 19 (2): 49–53. doi:10.1055/s-2006-942344. PMC 2780105. PMID 20011310.
  32. ↑ Quayle, Frank; Lowney, Jennifer (2006). "Colorectal Lymphoma". Clinics in Colon and Rectal Surgery. 19 (2): 049–053. doi:10.1055/s-2006-942344. ISSN 1531-0043.
  33. ↑ Arora M, Goldberg EM (July 2010). "Kaposi sarcoma involving the gastrointestinal tract". Gastroenterol Hepatol (N Y). 6 (7): 459–62. PMC 2933764. PMID 20827371.
  34. ↑ Lee HH, Kwon HM, Gil S, Kim YS, Cho M, Seo KJ, Chae HS, Cho YS (2017). "Endoscopic resection of asymptomatic, colonic, polypoid arteriovenous malformations: Two case reports and a literature review". Saudi J Gastroenterol. 23 (1): 67–70. doi:10.4103/1319-3767.199111. PMC 5329980. PMID 28139503.
  35. ↑ Shen SH, Chen JD, Tiu CM, Chou YH, Chiang JH, Chang CY, Lee CH (September 2005). "Differentiating colonic diverticulitis from colon cancer: the value of computed tomography in the emergency setting". J Chin Med Assoc. 68 (9): 411–8. doi:10.1016/S1726-4901(09)70156-X. PMID 16187597.
  36. ↑ Shen, Shu-Huei; Chen, Jen-Dar; Tiu, Chui-Mei; Chou, Yi-Hong; Chiang, Jen-Huei; Chang, Cheng-Yen; Lee, Chen-Hsen (2005). "Differentiating Colonic Diverticulitis from Colon Cancer: The Value of Computed Tomography in the Emergency Setting". Journal of the Chinese Medical Association. 68 (9): 411–418. doi:10.1016/S1726-4901(09)70156-X. ISSN 1726-4901.
  37. ↑ Sheiman, Laura; Levine, Marc S.; Levin, Alicia A.; Hogan, Jonathan; Rubesin, Stephen E.; Furth, Emma E.; Laufer, Igor (2008). "Chronic Diverticulitis: Clinical, Radiographic, and Pathologic Findings". American Journal of Roentgenology. 191 (2): 522–528. doi:10.2214/AJR.07.3597. ISSN 0361-803X.
  38. ↑ Jacobs, Danny; Solomon, Caren G. (2014). "Hemorrhoids". New England Journal of Medicine. 371 (10): 944–951. doi:10.1056/NEJMcp1204188. ISSN 0028-4793.
  39. ↑ Schlichtemeier S, Engel A (2016). "Anal fissure". Aust Prescr. 39 (1): 14–7. doi:10.18773/austprescr.2016.007. PMC 4816871. PMID 27041801.
  40. ↑ DuPont HL (January 2012). "Approach to the patient with infectious colitis". Curr. Opin. Gastroenterol. 28 (1): 39–46. doi:10.1097/MOG.0b013e32834d3208. PMID 22080825.
  41. ↑ 41.0 41.1 Fakhoury M, Negrulj R, Mooranian A, Al-Salami H (2014). "Inflammatory bowel disease: clinical aspects and treatments". J Inflamm Res. 7: 113–20. doi:10.2147/JIR.S65979. PMC 4106026. PMID 25075198.
  42. ↑ Iwańczak B, Iwańczak F (August 2017). "[Functional gastrointestinal disorders in children and adolescents. The Rome IV criteria]". Pol. Merkur. Lekarski (in Polish). 43 (254): 75–82. PMID 28875974.
  43. ↑ Choi D, Park H, Lee YR, Kook SH, Kim SK, Kwag HJ, Chung EC (2003). "The most useful findings for diagnosing acute appendicitis on contrast-enhanced helical CT". Acta Radiol. 44 (6): 574–82. PMID 14616200.
  44. ↑ Wolthuis AM, Meuleman C, Tomassetti C, D'Hooghe T, de Buck van Overstraeten A, D'Hoore A (November 2014). "Bowel endometriosis: colorectal surgeon's perspective in a multidisciplinary surgical team". World J. Gastroenterol. 20 (42): 15616–23. doi:10.3748/wjg.v20.i42.15616. PMC 4229526. PMID 25400445.


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